- Blue Shield of California (Long Beach, CA)
- …in nursing, health care or related field. 3+ years managed care experience preferred. Certified Case Manager (CCM) Certification or is in process of ... health and wellness in the outpatient setting. The Senior Care Manager will report to the ...minimum of 1 year experience in inpatient, outpatient or managed care environment required Health insurance/ managed… more
- Blue Shield of California (Rancho Cordova, CA)
- …or related field A minimum of 3+ year experience in inpatient, outpatient or managed care environment required Health insurance/ managed care experience ... outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population...care services based on medical necessity complying with contract for each appropriate plan type. Initiation of timely… more
- Sutter Health (Sacramento, CA)
- …support dispute litigation. Negotiations of proposed and/or existing payers or third-party payer managed care contracts . Supports the negotiation process and ... and trends for healthcare providers. + Ability to perform managed care contract analysis, draft...compliance. + Advanced knowledge of the operational implications of managed care contracts relative to… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …and problem resolutions regarding payment issues with all contracted payors. Manages the contract review process for RCSSD 3rd party contracts , contracts ... JOB SUMMARY: Responsible for seeking contract opportunities, reviewing contract language and...and terms, conducting data analysis on financial terms, negotiating contracts , and managing executed contracts for all… more
- Robert Half Legal (Rancho Cucamonga, CA)
- …Healthcare Organization! You will be joining a large legal team and become a Managed Care expert (MediCare). You will advise on regulatory and compliance issues, ... days per week (Tuesday-Thursday). The Counsel will be a manager -level position. The Counsel reports to the General Counsel...Ability to commute to Inland Empire 3 days/week + Managed care experience + Litigation experience in… more
- Robert Half Office Team (Murrieta, CA)
- …and negotiating contracts within a healthcare setting. Responsibilities: * Negotiate contracts within the managed care setting, ensuring all agreements ... a contract employment opportunity for a Network Contract Manager in the healthcare industry. This...provider network statuses. Requirements Minimum of 3 years of managed care contracting experience. Demonstrated success in… more
- Molina Healthcare (Los Angeles, CA)
- …field or an equivalent combination of education and experience **PREFERRED EXPERIENCE** : Managed Care experience To all current Molina employees: If you are ... and credentialing. **Job Duties** This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result… more
- LA Care Health Plan (Los Angeles, CA)
- …Account Manager III is responsible for the initial on-board training of new managed care contract provider partners, and for ensuring their provider ... LAC; and providing in-service orientation meetings with providers. Responsible for monitoring managed care contracts for renewals and expirations. Acts… more
- Sharp Electronics Corporation (Pleasanton, CA)
- **Overview** The Contract Coordinator position is responsible for the timely and accurate creation and processing of contract billing, in compliance with all ... procedures. **Responsibilities** + Ensure completeness and accuracy of maintenance contract documents including MICAS (meter automation) requirements and valid… more
- Stanford Health Care (Palo Alto, CA)
- … coordination, care progression and discharge planning. + Knowledge of managed care and commercial insurance, MediCal, Medicare, and other third-party ... (United States of America) **This is a Stanford Health Care job.** **A Brief Overview** The Manager -...function is to support Case Management, UR/UM and all care progression functions. Responsibilities include financial and contract… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: Minimum of 6 years of recent care management experience in a managed care setting, such as a health insurance environment and/or experience as ... state/federal compliance are met. + Track data related to contract compliance and member complaints. + Formulate reports and...care manager in a community based organization...care manager in a community based organization with at least… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: Experience serving Medi-Cal population. Preferred: Understanding of Medi-Cal managed care model, eligibility requirements, benefits, enrollment ... Product Solutions Manager III (Medicare) Job Category: Administrative, HR, Business...processes, and regulatory requirements governing Medi-Cal managed care plans. Understanding of … more
- Microsoft Corporation (Santa Clara, CA)
- …the lifecycle of the contracts . + Contribute to supplier evaluation and prepare contract award proposals on an as needed basis. + Contract Review and ... via a valid passport. **Preferred Qualifications:** + Experience developing and negotiating contract terms and conditions specifically for contracts related to… more
- LA Care Health Plan (Los Angeles, CA)
- …Independent judgment and action skills to facilitate change as needed. Knowledge of managed care industry standard performance assessment methods. Able to work ... Clinical Quality Program Manager II (CAHPS) Job Category: Clinical Department: Quality... Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed… more
- LA Care Health Plan (Los Angeles, CA)
- Enterprise Shared Services Program Manager II (Limited Duration- 12 months)) Job Category: Administrative, HR, Business Professionals Department: Claims Data and ... $152,762.00 (Mid.) - $188,015.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created...that purpose. Job Summary The Enterprise Shared Services Program Manager II is responsible for leading and managing a… more
- Randstad US (Pleasanton, CA)
- …knowledge of federal and state regulations, laws and accreditation standards related to health care and managed care organizations. + Knowledge of member ... job details job summary: We have a 1 year contract opportunity for a Case Manager in...state regulations, laws and accreditation standards related to health care and managed care organizations.… more
- Sunnyside Nursing and Post-Acute Care (Torrance, CA)
- …with business office and medical records to ensure accurate census and payment of managed care and Medicare residents + Attend scheduled meetings and care ... atmosphere, whether residents stay for short-term treatment or long-term care . Case Manager coordinates the delivery of...Ability to understand and interpret medical terminology, diagnoses, and contracts + Ability to read or quickly pick up… more
- LA Care Health Plan (Los Angeles, CA)
- …operations. At least 3-4 years of supervisory/ management experience in healthcare or managed care industry. Experience with BI reporting tools. Knowledge and ... Manager , Encounters Job Category: Administrative, HR, Business Professionals...Care Services (DHCS) and other government agencies, understanding contract obligations, requirements of encounter data extraction and submission.… more
- Stanford Health Care (Menlo Park, CA)
- …Day - 08 Hour (United States of America) **This is a Stanford Health Care job.** **Additional Job Description:** Located in the heart of Silicon Valley, Stanford ... Health Care 's mission is to heal humanity through science and...adequate staffing levels to support daily operations. + Oversees contract administration needs including initiation, vendor performance and financial… more
- Elevance Health (Cerritos, CA)
- …licensed in **Oregon, Washington State, California, Idaho, or Utah.** The Behavioral Health Care Manager II is responsible for managing psychiatric and substance ... effective setting in accordance with UM Clinical Guidelines and contract . + Refers cases to Peer Reviewers as appropriate....or territory of the United States required. + Prior managed care experience required. For URAC accredited… more
